Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

Sef, Davorin; Sef, Alessandra Verzelloni; Mohite, Prashant N.; Stock, Ulrich A.; Trkulja,; Raj, Binu; Sáez, Diana García; Mahesh, Balakrishnan; Robertis, Fabio De; Simon, Andrè

doi:10.1111/tri.13754

Cited by 12 publications

(17 citation statements)

References 29 publications

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“…Our controlled DCD program has increased potential lung donors without reducing DBD donor opportunities, subsequently resulting in increased LTx numbers with comparable outcomes to those seen following DBD [2,23,24]. We have previously reported no significant difference between DCD vs DBD LTx in 30‐day and 3‐year mortality [25], although more early postoperative events following DCD LTx have been reported in other studies [26,27].…”

Section: Discussionmentioning

confidence: 98%

Improving the predictability of time to death in controlled donation after circulatory death lung donors

et al. 2021

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Although the use of donation after circulatory death (DCD) donors has increased lung transplant activity, 25-40% of intended DCD donors do not convert to actual donation because of no progression to asystole in the required time frame after withdrawal of cardiorespiratory support (WCRS).No studies have specifically focussed on DCD lung donor progression. This retrospective study reviewed intended DCD lung donors to make a prediction model of the likelihood of progression to death using logistic regression and classification and regression tree (CART). Between 2014 and 2018, 159 of 334 referred DCD donors were accepted, with 100 progressing to transplant, while 59 (37%) did not progress. In logistic regression, a length of ICU stay ≤ 5 days, severe infra-tentorial brain damage on imaging and use of vasopressin were related with the progression to actual donation. CART modelling of the likelihood of death within 90-minute post-WCRS provided prediction with a sensitivity of 1.00 and positive predictive value of 0.56 in the validation data set. In the nonprogressed DCD group, 26 died within 6 h post-WCRS. Referral received early after ICU admission, with nonspontaneous ventilatory mode, deep coma and severe infra-tentorial damage were relevant predictors. The CART model is useful to exclude DCD donor candidates with low probability of progression.

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Section: Discussionmentioning

confidence: 98%

Improving the predictability of time to death in controlled donation after circulatory death lung donors

et al. 2021

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“…A post hoc analysis of our recent study 9 on clinical outcomes in LTx was conducted. For the present analysis, among all consecutive LTx performed between April 2017 and March 2019 at our tertiary center (n = 105), we excluded recipients where lungs were reconditioned with ex vivo lung perfusion (EVLP) (due to a considerable imbalance between the DCD and DBD patients) and who received RRT preoperatively.…”

Section: Methodsmentioning

confidence: 99%

“…Surgical technique of the donor organ procurement and bilateral sequential single LTx were described by our group earlier. 9,10 According to the institutional transplant guidelines, all LTx recipients received the same initial immunosuppression, with doses adjusted according to target drug levels and the presence of infections or kidney toxicity. All patients received intravenous methylprednisolone intraoperatively; Tacrolimus, mycophenolate mofetil, and prednisolone were given as maintenance therapy.…”

Section: Methodsmentioning

confidence: 99%

Postoperative acute kidney injury and renal replacement therapy after DCD lung transplantation

Sef

Trkulja

et al. 2021

Clinical Transplantation

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Acute kidney injury (AKI) after lung transplantation (LTx) is a common complication.We aimed to assess whether donation after circulatory death (DCD) is associated with an increased risk of AKI and renal replacement therapy (RRT) in the early postoperative period compared to the donation after brain death (DBD). Retrospective data on a cohort (N = 95) of LTx patients (DCD n = 17, DBD n = 78) characterized by no use of ex-vivo lung perfusion were analyzed for the incidence of AKI within 30 postoperative days and incidence of RRT within 7 and 30 days. After optimal full matching, an imbalance remained between the DCD and DBD patients in respect to intraoperative use of cardiopulmonary bypass (CPB). Therefore, a further subset (n = 77) was defined that excluded CPB patients, and matching was repeated (DCD n = 13 vs. DBD n = 63) resulting in a fair balance on a range of preoperative characteristics and intraoperative use of ECMO. In both matched subsets, DCD was associated with around twice higher risk of AKI and RRT within 7 and 30 postoperative days. In conclusion, data suggest that DCD could be associated with worse early renal outcomes in a subset of LTx patients and justify further studies on the topic in order to refine further renal care pathways perioperatively.

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“…Donor lung assessment, procurement and preservation were described earlier by our group. [16][17][18]…”

Section: Patient Selectionmentioning

confidence: 99%

“…Surgical technique of LTx was described by our group in earlier reports. 16 Intraoperative mechanical circulatory support was considered in the case of severe pulmonary hypertension, inability to tolerate one-lung ventilation, and hemodynamic instability after pulmonary artery clamping. Most commonly, patients who were bridged to transplantation with VV-ECMO were transplanted on VV-ECMO; however, in some cases, intraoperative conversion to veno-arterial (VA) ECMO was required.…”

Section: Vv-ecmo and Surgical Techniquementioning

confidence: 99%

Mid-Term Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: Comparison with Non-Bridged Recipients

Trkulja

et al. 2021

Preprint

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Objectives: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly being used in acutely deteriorating patients with end-stage lung disease as a bridge to transplantation (BTT). It can allow critically ill recipients to remain eligible for lung transplant (LTx) while reducing pretransplant deconditioning. We analyzed early and mid-term postoperative outcomes of patients on VV-ECMO as a BTT and the impact of preoperative VV-ECMO on posttransplant survival outcomes. Methods: All consecutive LTx performed at our institution between January 2012 and December 2018 were analyzed. After matching, BTT patients were compared with non-bridged LTx recipients. Results: Out of 297 transplanted patients, 21 (7.1%) were placed on VV-ECMO as a BTT. After matching, we observed a similar 30-day mortality between BTT and non-BTT patients (4.6% vs. 6.6%, p=0.083) despite a higher incidence of early postoperative complications (need for ECMO, delayed chest closure, acute kidney injury). Furthermore, preoperative VV-ECMO did not appear associated with 30-day or 1-year mortality in both frequentist and Bayesian analysis (OR 0.35, 95%CI 0.03-3.49, p=0.369; OR 0.27, 95%CrI 0.01-3.82, P=84.7%, respectively). In sensitivity analysis, both subgroups were similar in respect to 30-day (7.8% vs. 6.5%, p=0.048) and 1-year mortality (12.5% vs. 18%, p=0.154). Conclusions: Patients with acute refractory respiratory failure while waiting for LTx represent a high-risk cohort of patients. We observed that these patients can be successfully bridged to LTx with VV-ECMO with post-transplant mortality comparable to non-BTT patients.

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Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

Cited by 12 publications

References 29 publications

Improving the predictability of time to death in controlled donation after circulatory death lung donors

Improving the predictability of time to death in controlled donation after circulatory death lung donors

Postoperative acute kidney injury and renal replacement therapy after DCD lung transplantation

Mid-Term Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: Comparison with Non-Bridged Recipients

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